Wooden Chest Syndrome: A Case Report of Fentanyl-Induced Chest Wall Rigidity

Rosal, Nathaniel; Thelmo, Franklin; Tzarnas, Stephanie; DiCalvo, Lauren; Tariq, Sohaib; Grossman, Craig E.

doi:10.1177/23247096211034036

Cited by 10 publications

(9 citation statements)

References 6 publications

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“…Common clinical features include altered mental status ranging from lethargy to coma, miosis, bradycardia, hypotension, and hypoxia. A unique feature specific to fentanyl is “wooden chest syndrome”, which involves rigidity of the abdominal muscles and diaphragm, inducing respiratory failure [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

A Peculiar Case of Fentanyl-Induced Cardiomyopathy

Badar¹,

Ashraf²,

Bhuiyan³

et al. 2022

Cureus

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An alarming rise in prescription and non-prescription misuse of opioids has been observed recently, leading to potentially devastating consequences. Opioid misuse contributes to cardiac risk burden and can cause diseases such as acute coronary syndrome, congestive heart failure, arrhythmias, QTc prolongation, and endocarditis. Here, we describe the case of a 35-year-old male with recreational fentanyl use who was found to have a cardiogenic shock on point-of-care ultrasound (POCUS), likely due to fentanyl-induced cardiomyopathy. Opioid-induced cardiomyopathy without any underlying cardiac disease in an adult appears to be a rare case. Our case highlights the importance of promptly recognizing fentanyl toxicity, screening for possible cardiomyopathy secondary to its use, and emergent resuscitation with the maintenance of ventilation, diuretics, and vasopressor support. The use of the reversal agent, naloxone, is a crucial part of management.

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Section: Discussionmentioning

confidence: 99%

A Peculiar Case of Fentanyl-Induced Cardiomyopathy

Badar¹,

Ashraf²,

Bhuiyan³

et al. 2022

Cureus

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“…Fentanyl, a synthetic opioid, is well‐known for its potency, which in humans is considerably higher than that of morphine (Bremer et al., 2016; O'Donnell et al., 2017; Somerville et al., 2017). There is increasing awareness that fentanyl could pose a greater risk than alternative opioid therapeutics, primarily due to its supposed propensity to induce chest wall rigidity – a condition collectively known as ‘wooden chest syndrome’, which has been observed in both humans and rodents (Baruah et al., 2022; Grell et al., 1970; Haouzi & Tubbs, 2022; Rosal et al., 2021; Scamman, 1983; Streisand et al., 1993; Torralva & Janowsky, 2019). This is less frequently associated with use of morphine and other opioid‐based analgesics (Pergolizzi et al., 2021) further emphasizing the importance of better understanding the differential effects of these opioids.…”

Section: Introductionmentioning

confidence: 99%

A comparative examination of morphine and fentanyl: unravelling the differential impacts on breathing and airway stability

Burgraff,

Baertsch,

Ramirez

2023

The Journal of Physiology

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This study provides an in‐depth analysis of the distinct consequences of the opioid drugs morphine and fentanyl during opioid‐induced respiratory depression (OIRD). We explored the physiological implications of both drugs on ventilation and airway patency in anaesthetized mice. Our results revealed a similar reduction in respiratory frequency with equivalent scaled dosages of fentanyl and morphine, though the onset of suppression was more rapid with fentanyl. Additionally, fentanyl resulted in transient airflow obstructions during the inspiratory cycle, which were absent following morphine administration. Notably, these fentanyl‐specific obstructions were eliminated with tracheostomy, implicating the upper airways as a major factor contributing to fentanyl‐induced respiratory depression. We further demonstrate that bronchodilators salbutamol and adrenaline effectively reversed these obstructions, highlighting the bronchi's contribution to fentanyl‐induced airflow obstruction. Our study also uncovered a significant reduction in sighs during OIRD, which were eliminated by fentanyl and markedly reduced by morphine. Finally, we found that fentanyl‐exposed mice had reduced survival under hypoxic conditions compared to mice given morphine, demonstrating that fentanyl becomes more lethal in the context of hypoxaemia. Our findings shed light on the distinct and profound impacts of these opioids on respiration and airway stability and lay the foundation for improved opioid use guidelines and more effective OIRD prevention strategies. imageKey points Both morphine and fentanyl significantly suppressed respiratory frequency, but the onset of suppression was faster with fentanyl. Also, while both drugs increased tidal volume, this effect was more pronounced with fentanyl. Fentanyl administration resulted in transient obstructions during the inspiratory phase, suggesting its unique impact on airway stability. This obstruction was not observed with morphine. The fentanyl‐induced obstructions were reversed by administering bronchodilators such as salbutamol and adrenaline. This suggests a possible therapeutic strategy for mitigating the adverse airway effects of fentanyl. Both drugs reduced the frequency of physiological sighs, a key mechanism to prevent alveolar collapse. However, fentanyl administration led to a complete cessation of sighs, while morphine only reduced their occurrence. Fentanyl‐treated mice showed a significantly reduced ability to survive under hypoxic conditions compared to those administered morphine. This indicates that the impacts of hypoxaemia during opioid‐induced respiratory depression can vary based on the opioid used.

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“…In this study, we investigated two situations: opioid-induced muscle rigidity and complete muscle relaxation. Opioidinduced muscle rigidity is called lead-pipe rigidity during anaesthetic induction for surgery and wooden chest syndrome in intensive care [12,13]. In addition, completely relaxed muscles are produced by administering muscle relaxants during anaesthetic induction.…”

Section: Introductionmentioning

confidence: 99%

Quantification of muscle tone using shear-wave velocity during anaesthesia induction: a prospective observational study

Saito

Sugino

Moteki

et al. 2022

Preprint

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Purpose Shear-wave elastography is a non-invasive ultrasound method that provides quantitative information on the elasticity of soft tissues. However, a universal velocity scale for quantification has yet to be developed. This study aimed to determine the shear-wave velocities (SWVs) of the abdominal muscles during anaesthesia induction for future development of a universal scale. Methods We enrolled 75 adult patients who received elective surgery with an American Society of Anesthesiologists physical status of I–III from December 2018 to March 2021. We measured and calculated the SWVs before and after opioid administration (baseline at rest and opioid-induced rigidity condition) and after muscle relaxant administration (zero reference condition). The SWV value was adjusted for subcutaneous fat thickness using our proposed corrections. The SWVs after the adjustment were compared among the values at baseline, opioid-induced rigidity, and complete muscle relaxation using one-way repeated-measures analysis of variance and post-hoc Tukey–Kramer tests. Significance was set at p < 0.05. Results The SWVs in the baseline, opioid-induced rigidity, and complete muscle relaxation conditions after adjustment were 2.08 ± 0.48, 2.41 ± 0.60, and 1.79 ± 0.30 m/s, respectively (p < 0.001 for all comparisons). Conclusion The SWV as reference was 1.8 m/s, and the SWVs at rest and opioid-induced rigidity were ~ 10% and ~ 30% higher than the reference, respectively. SWV adjusted for subcutaneous fat thickness may be a scale point for the assessment of muscle tone. Clinical trial registration: UMIN Clinical Trials Registry identifier UMIN000034692, registered on October 30th, 2018

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Wooden Chest Syndrome: A Case Report of Fentanyl-Induced Chest Wall Rigidity

Cited by 10 publications

References 6 publications

A Peculiar Case of Fentanyl-Induced Cardiomyopathy

A Peculiar Case of Fentanyl-Induced Cardiomyopathy

A comparative examination of morphine and fentanyl: unravelling the differential impacts on breathing and airway stability

Quantification of muscle tone using shear-wave velocity during anaesthesia induction: a prospective observational study

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